Previous Collaborative Projects

Hormone Therapy & Mammography Working Group (2006-2010)

Purpose: This working group assessed the impact of use of Hormone Therapy (HT) on breast cancer screening performance across countries.

Members: Brian Cox (chair), Rachel Ballard-Barbash, Mireille Broeders, Emily Dowling, Berta Geller, Nea Malila, Rene Shumak, Stephen Taplin

Activities: The group surveyed international screening programs about their recording of the use of HT; assessed which programs have sufficient data for analysis of the effectiveness of mammography in HT users versus non-HT users; recorded how breast density is measured and recorded in these screening programs.

Results from this working group include the following publication:
Cox B, Ballard-Barbash R, Broeders M, Dowling E, Malila N, Shumak R, Taplin S, Buist D, Miglioretti D; International Cancer Screening Network. Recording of hormone therapy and breast density in breast screening programs: summary and recommendations of the International Cancer Screening Network. Breast Cancer Res Treat 2010 Dec;124(3):793-800. [View Abstract]

Communications Working Group (2002-2006)

Purpose: To identify and encourage "best practices" in communicating information about screening mammography, and develop communication materials that countries can tailor for use in their specific populations.

Members: Berta Geller (chair), Rachel Ballard-Barbash, Greg Doyle, Livia Giordani, Solveig Hofvind, Larry von Karsa, Andriana Koukari, Noriaki Ohuchi, Gonzalo Pou, Gad Rennert, Hélène Sancho-Garnier, Astrid Scharpantgen, Nereo Segnan, Jane Zapka

Activities: The initial assessment of these international communication materials has been summarized in two journal articles that describe the content and types of materials used in different countries:

1. Geller BM, Zapka J, Hofvind SS, Scharpantgen A, Giordano L, Ohuchi N, Ballard-Barbash R. Communicating with women about mammography. J Cancer Educ 2007;22(1):25-31. [View Abstract]
2. Zapka JG, Geller BM, Bulliard JL, Fracheboud J, Sancho-Garnier H, Ballard-Barbash R; The IBSN Communications Working Group. Print information to inform decisions about mammography screening participation in 16 countries with population-based programs. Patient Educ Couns 2006 Oct;63(1-2):126-37. [View Abstract]

Following this initial assessment, members from many countries identified the need for hands-on guidance about "best practices" to consider in developing print materials. A sub-group developed Designing Print Materials: A Communications Guide for Breast Cancer Screening, which was published in 2007 to address this need. Authors included Berta Geller, Jane Zapka, Scott Connolly, Caroline Cranos, and Livia Giordano.

Performance Parameters Evaluation Group (1997-2009)

Purpose: The group focused on enhancing understanding of intermediate measures of screening mammography performance and variations in these measures across countries. A recently completed activity involved the examination of recall rates and comparison of the recall rate with cancer detection rates to facilitate understanding of program variation in these measures.

Members: Jacques Fracheboud (chair), Rosemary Ancelle-Park, Jean-Luc Bulliard, Solveig Hofvind, Carrie Klabunde, Jean-Pierre de Landtsheer, Gonzalo Pou, Gad Rennert, Steinar Thoresen, Bonnie Yankaskas

Activities: Three publications were published from this group.

1. Bulliard JL, Sasieni P, Klabunde C, De Landtsheer JP, Yankaskas BC, Fracheboud J. Methodological issues in international comparison of interval breast cancers. Int J Cancer 2006 Sep 1;119(5):1158-63. [View Abstract]
2. Yankaskas BC, Klabunde CN, Ancelle-Park R, Renner G, Wang H, Fracheboud J, Pou G, Bulliard JL; International Breast Cancer Screening Network. International comparison of performance measures for screening mammography: can it be done? J Med Screen 2004;11(4):187-93. [View Abstract]
3. Hofvind S, Yankaskas BC, Bulliard JL, Klabunde CN, Fracheboud J. Comparing interval breast cancer rates in Norway and North Carolina: results and challenges. J Med Screen 2009;16(3):131-9. [View Abstract]

Mortality Evaluation Group (MEG)

Purpose: The group considers designs to evaluate the impact of population-based screening mammography on breast cancer mortality and other endpoints.

Members: Lennarth Nyström (Co-Chair), Sue Moss (Co-Chair), Ahti Antilla, Caroline Baan, Rachel Ballard-Barbash, Bill Barlow, Mireille Broeders, Harry de Koning, Eugenio Paci, Tiina Salminen, Stephen Taplin, Noel Weiss

Activities: This group has been considering ways to evaluate the effectiveness of mammography in practice. Meetings over several years have reported results from innovative controlled observational studies in Sweden and other Nordic countries. The Nordic countries have the advantage that their population registries and data systems facilitate the tracking of cohorts. In other countries without such registries, case-control evaluations have taken place. Given the controversies raised by some reviews of published trials, there is building pressure within many countries to show that programs are effective. Consideration has been given to the best method for doing this, and the growing consensus is that case-control methodologies do not offer the precision necessary to establish effectiveness in practice. Ascertaining screening exposure and separating program effects from usual care effects is nearly impossible with the widespread use of screening. The focus of the group has therefore turned to cohort studies in countries with good data systems, and identification of key process measures such as screening rates; mammography interpretive characteristics like sensitivity, specificity, and positive predictive value; recall rates; and treatment rates. Evaluation of programs in countries without registries focuses upon establishing measures of process comparable to those demonstrated in countries where programs have been shown to have an impact.

Quality Assurance Working Group (1997-2000)

Purpose: In 1997, the ICSN undertook a quality assurance program assessment. The purpose of this assessment was to determine the scope of quality assurance activities for population-based screening mammography across ICSN countries. Specific components of the assessment included:

1. the organization of quality assurance for screening mammography;
2. quality control practices;
3. quality assurance in follow-up and treatment; and
4. quality assurance for data to evaluate screening mammography program performance.

Members: Carrie Klabunde (Co-Chair), Rachel Ballard-Barbash (Co-Chair), Francoise Bouchard, Mary Codd, Andre Grivegnee, Ed Hendrick, Sue Moss, Vitor Rodriques, Hélène Sancho-Garnier, Astrid Scharpantgen, Stephen Taplin

Activities: The Quality Assurance Working Group was active until 2000 when it split into the Performance Parameters Evaluation Group and the Mortality Evaluation Group. Twenty-three countries participated in the assessment. Four papers summarizing project results have been published as listed below:

1. Hendrick RE, Klabunde C, Grivegnee A, Pou G, Ballard-Barbash R. Technical quality control practices in mammography screening programs in 22 countries. Int J Qual Health Care 2002 Jun;14(3):219-26. [View Abstract]
2. Klabunde CN, Sancho-Garnier H, Taplin S, Thoresen S, Ohuchi N, Ballard-Barbash R; International Breast Cancer Screening Network. Quality assurance in follow-up and initial treatment for screening mammography programs in 22 countries. Int J Qual Health Care 2002 Dec;14(6):449-61. [View Abstract]
3. Klabunde C, Bouchard F, Taplin S, Scharpantgen A, Ballard-Barbash R; International Breast Cancer Screening Network (IBSN). Quality assurance for screening mammography: an international comparison. J Epidemiol Community Health 2001 Mar;55(3):204-12. [View Abstract]
4. Klabunde CN, Sancho-Garnier H, Broeders M, Thoresen S, Rodrigues VJ, Ballard-Barbash R. Quality assurance for screening mammography data collection systems in 22 countries. Int J Technol Assess Health Care 2001 Fall;17(4):528-41. [View Abstract]

Group on Assessment of Organized Screening Programs (1995-2011)

Purpose: In an effort to document and better understand the nature of the screening programs in its member countries, the ICSN has undertaken three program assessments. The assessments have covered screening policies, funding, guidelines, and program organization. Nine countries participated in a 1990 program assessment; 22 countries participated in a 1995 program assessment; and 27 participated in a 2008 program assessment.

Members: Rachel Ballard-Barbash, Mireille Broeders, Mary Codd, Ann Coleman, Emily Dowling, Carrie Klabunde, Harry de Koning, Jacques Fracheboud, Sue Moss, Eugenio Paci, Julietta Patnick, Sam Shapiro, Sylvie Stachenko

Activities: The results of these assessments are summarized in three publications:

1. Ballard-Barbash R, Klabunde C, Paci E, Broeders M, Coleman EA, Fracheboud J, Bouchard F, Rennert G, Shapiro S. Breast cancer screening in 21 countries: delivery of services, notification of results and outcomes ascertainment. Eur J Cancer Prev 1999 Oct;8(5):417-26. [View Abstract]
2. Shapiro S, Coleman EA, Broeders M, Codd M, de Koning H, Fracheboud J, Moss S, Paci E, Stachenko S, Ballard-Barbash R. Breast cancer screening programmes in 22 countries: current policies, administration and guidelines. International Breast Cancer Screening Network (IBSN) and the European Network of Pilot Projects for Breast Cancer Screening. Int J Epidemiol 1998 Oct;27(5):735-42. [View Abstract]
3. Dowling EC, Klabunde C, Patnick J, Ballard-Barbash R; International Cancer Screening Network (ICSN). Breast and cervical cancer screening programme implementation in 16 countries. J Med Screen 2010;17(3):139-46. [View Abstract]